Prescription drug use among the elderly is at an all-time high, says the American Society of Consultant Pharmacists. Those aged 65 to 69 take an average of 15 prescriptions per year, while those 80 to 84 take an average of 18 prescriptions. This prescribing phenomenon has been dubbed “polypharmacy,” and is potentially very dangerous.
A just-published study from the United Kingdom found that certain classes of drugs increase the risk of dementia by nearly 50 percent.
Doctors prescribe these anticholinergic drugs to treat various conditions common among senior patients, including chronic obstructive pulmonary disease (COPD), Parkinson’s disease, gastrointestinal disorders and bladder conditions. Anticholinergics go by numerous brand names; the Mayo Clinic provides a comprehensive list.
Compounding the issue, statistics show that 40 to 75 percent of older adults do not take their medications correctly. Clearly, proper medication management is critical to a senior’s health and well being.
10 Crucial Questions to Ask Your Doctor or Pharmacist
For caregivers and family care providers, becoming fully informed is the first step. While doctors are notoriously pressed for time, if you arrive for the appointment well prepared, you can gather the necessary information to accurately monitor the senior in your care.
Here are the essential questions to ask about any new prescription medication:
- Why is this medicine being prescribed? What is it intended to do?
- How will the senior feel once he/she starts taking it?
- What results (in terms of symptom improvement) should I look for? In what timeframe?
- How long will he/she need to take this medicine?
- Should it be taken with food or between meals? Will any foods or drinks interfere with its action?
- How will this medicine interact with other prescribed and OTC medications the senior is taking? (Come prepared with a list of all current prescriptions!)
- What side effects, if any, should I watch for?
- Are there any activities the senior should avoid while taking this medication?
- If the senior misses a dose, or mistakenly takes too much, what should I do?
- Is there a less expensive generic version? Will it work the same way? (Be aware that generic drugs are often manufactured overseas and do not have FDA quality control, and thus may pose dangers that are not worth the cost savings.)
Learn Prescription Abbreviations
While it’s well known that doctors’ handwriting can be illegible, a caregiver workaround is learning what those arcane medical abbreviations mean.
Some of the most common abbreviations doctors and pharmacists use on medication bottles are as follows. You can write these on a notecard and affix it to the senior’s refrigerator or bathroom mirror.
Common abbreviations on prescription medications:
- p.r.n.: as needed
- a.c.: before meals
- p.c.: after meals
- p.o.: by mouth
- q.d.: every day
- b.i.d.: twice a day
- t.i.d.: three times a day
- q.i.d.: four times a day
- h.s.: at bedtime
- ea.: each
Red Flags for MRPs
Because older bodies process and respond to medications differently than younger adults, there is a greater risk of side effects. How will you know if a medication-related problem (MRP) arises?
Typical MRPs include:
- Muscle weakness
- Loss of Appetite
- Changes in memory or speech.
It’s especially vital that a caregiver recognize an MRP for what it is, because these reactions can also be symptoms of the condition that is being treated. It’s critically important that a senior not be unnecessarily prescribed medication for a symptom of another medication. This is how toxic results occur.
For example, if an older adult is prescribed a certain medication and experiences depression, which is a known possible side effect, the caregiver needs to inform the physician of this reaction so that the senior is not prescribed an unnecessary antidepressant.
MRPs can also occur when the prescribed dose is too low or too high. Changes in the distribution of body fat and muscle, along with more sluggish kidneys and liver that aren’t removing medications from the body as quickly as when they were younger, typically indicate that a normal dose for a younger person may be too high for a senior.
Smart Safeguards for Caregivers and Families
- Create a medication record. You’ve already made a list of the senior’s current medications for the last doctor’s appointment. Keep this list updated on your computer with a medication record form, and print out a fresh copy for the senior and family members each time there is any change. According to the Centers for Disease Control and Prevention (CDC), adverse drug events cause almost half a million ER visits each year, more than twice as many as for younger people.
- Use pillboxes. Smart pillboxes have sensors that can detect if your loved one hasn’t taken their medication, and will alert the caregiver before a dose is missed. Medication management apps such as Medisafe and CareZone provide a more sophisticated level of monitoring.
- Use one pharmacy. Filling all prescriptions through a single pharmacy is one of the simplest ways to prevent drug interactions and make getting refills easy, because the staff will know what prescriptions your loved one is taking.
- Synchronize medication refills. Ask your pharmacist to have your loved one’s long-term medications refilled on the same day. Patients with synchronized medications find it easier to manage their refills, and this improves overall medication adherence. Most pharmacies offer automatic refills, along with phone or text message reminders.
- Store all medications in a designated location. Keep medications together in one place unless they require refrigeration or are labeled “store in a cool place.” This will help if an emergency situation arises.
- Keep refrigerated medications separate. Consider keeping refrigerated medications in a plastic box or container in a consistent location in the refrigerator.
- Reduce the number of medications if possible. Ask the doctor if it is possible to limit the number of medications your senior loved one is taking.
- Toss all expired medications.
Communication is Crucial
The key to proper medication management for seniors is clear, effective communication with the health care team. This includes presenting actual or potential medication-related problems in a timely manner to the physician, and participating in resolving these issues.
As a Brown University Long-term Care Quality Letter states, “Any symptom in an elderly patient should be considered a medication-related problem until proved otherwise.”
This is the kind of informed, cautionary care that will help keep your senior loved one safe.